DESCRIPTION (Taken from the applicant's Abstract) Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS) affects men of all ages. Cytokines are important inflammatory mediators. We have shown a direct significant correlation between the levels of interleukin-1-beta (IL-1-beta) and white blood cells. Furthermore IL-1-beta levels were significantly higher in expressed prostatic secretion (EPS) of men with inflammatory CPPS than in controls. The specific aims are to investigate: 1. Cytokines in CPPS. We will test the hypothesis that cytokines are important in CPPS by measuring IL-1-beta, TNF-alfa (tumor necrosis factor-alpha), IL-6, and IL-8 in EPS and prostate tissue collected from 150 men with CPPS. We will correlate cytokine levels, symptoms, urodynamic findings, and response to behavioral modification and utilization, to classify patients and to determine the role of anticytokine therapy. 2. Infectious agents and CPPS. We will test the hypothesis that infectious agents are important in CPPS using rRNA probes and polymerase chain reaction (PCR) to search for the presence of fastidious bacteria and viruses in prostate biopsy specimens from men with CPPS. We will determine whether the organisms associated with inflammatory CPPS differ from those associated with noninflammatory CPPS and correlate these finding with the presence of cytokines. These findings will provide important new insights into the pathogenesis of CPPS and allow the development of potential antimicrobial therapy for CPPS. 3. Voiding Dysfunction/Biofeedback and CPPS. We will test the hypothesis that men with CPPS have dysfunctional voiding and that symptoms can be improved through biofeedback. Men will be randomized to biofeedback or no biofeedback. This study will provide insight into relationships between CPPS, the clinical indications for urodynamics in evaluating patients, and response to behavioral modification in these patients. 4a. Effectiveness of biofeedback treatment. We will test the hypothesis that patients who receive biofeedback treatment will have better outcomes as measured by health status, a reduction in symptoms or an improvement in functional status, an improvement of quality of life, and a reduction in healthcare utilization as measured by visits, tests, and contacts. diagnostic, management, and treatment pathways for cost-effective care for men with CPPS. This project will provide important new insights into the pathogenesis and management of men with CPPS.